Provider Demographics
NPI:1326500851
Name:PROBERT, SETH M (DO)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:M
Last Name:PROBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 SANTA CANDIDA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1522
Mailing Address - Country:US
Mailing Address - Phone:801-822-8544
Mailing Address - Fax:
Practice Address - Street 1:850 CENTRAL PKWY E STE 275
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5542
Practice Address - Country:US
Practice Address - Phone:972-881-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TXU0645208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program